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ENC2018-00094 CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No.: (g AC7L�9 DEPT.OF PUBLIC WORKS (for working within the X-Ref. File 70 North First Street public:right-of-way) Application Date /!� Campbell,CA 95008 Issued li` /t,11 Ph.(408)866-2150 w Application Expiration Date Fx. (409)376-0958 t 7 / APN Permit Expiration Date APPLICATION-Application is herebymade fora Public Works Permitin accordance with Ca mpbel I Municipal Code,Section11.04.(Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address: 7(} N. First Street, Campbell City Hall Campbell Ca. 95008 B. Nature of Work/Utility Trench Location: Campbell Veterans Memorial Paver Inlay Project (CVMF) ® No Fee Permit for work related to City Project, Project Name: CVMF Paver Inlay Project C. Attach four(4)copies of an engineered plan showing the location and extent of the work,and four(4)copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer,said plan becomes a part of this permit. D. Allworkshall conform totheCityofCampbell5tandardSpecificationsandDetailsfor Public Works Construction;the GeneralPermitConditions listed on the reverse side;and the Special Provisions for this permit,listed below.Failure to abide by these conditions and provisions may result injob shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. E. The Contractor must have this permit and approved plans atthe site and must notifythe Public Works Departmentat leasttwo days before starting work- Notice must be given to Public Works at least 24 hours before restarting any work. Name of Applicant: Telephone: Campbell Veterans Memorial Fndn. Inc. 408-370-2200 Address: P .C)_ Roy 622 ,' Campbell , Ca_ 95009 E-mail Address: -jamesf733 yahoo.com 24-HOUR EMERGENCY PHONE NUMBER: 408-370-2200 Is this work being done by the property owners at their own residence? ❑ Yes No The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,its officers,agents,and employees free,safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the information.Applicant is advised that upon Issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arising out of improvements completed in the public right-of-way. Accepted: Campbell Veterans Memorial Fandatior-1 Inc : "f? ,,y: 3/28/2018 (Applicant Permittee) (sign) /( im Free) Date Strouss Brothers Construction, (Contractor) (Print Name) Date SPKIAL PROVISIONS: Street shaII not bea pen cutfar Lind ergroundinstalIatians.Minim urn cuts Maybe allowedfor can nectionsorexplorationholes.Such cuts maybe gparifirallyapproved.' by the ns rn r'Mr nrinr M rut:i:ng. 2. Pavement may be cuL for underground installations and must be restored in accordance with lire Standard Details Trench Restoration PAethod I "A",unless otherwise approved by the Engineer. 3. Work_o be staked by a licensed Land Surveyor or Civil Engineer and two(2)copies oi'the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4216 of the Government Code this permit is not valid for excavations until Underground Service Alert(USA)has been notified and 1 the inquiry identification number has been entered hereon. USA Phone: 1-800-227-2600. USATICKET NO. j S. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. i 6. Public Notification Requirements: SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT t j RECEIPT NO. PERMIT APPLICATION FEE $ d� PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE $, ��Q EMERGENCY PERMIT FEE $ APPROVED FOR ISSUANCE l For City Engineer Date } Per it Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIONS 1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City_Insurance shall Le maintained for the duration of the permit work. 2. A Construction•,Cash Deposit is required.Changes will be made againstthis depositif there is an emergency call-out,overtime inspection orwhen City ordered barricading is required.Any such costs in excess of the deposit will be billed to the Permittee. 3. Refund of the construction cash deposit balance and refund orcancellation of the Faithful Performance Suretywill be initiated by the written acceptance ofthe work by the City. 4; A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City.Surety posted shall be equal to 25%of the original Faithful Performance Security. S. Submit project schedule 10(ten)days priorto proposed stars:of work.Additional lead time may be.equired for work within City facilities and downtown Campbell. 6. The Permitt2e must request in writing a final inspection and acceptance of the work upon completion.Acceptance by the CitywUl be made in writing to the Permittee. 7. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and watervalves. 8. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures,detours,and street closures.This plan must be reviewed and approved prierto any lane closures. 9. A Construction Traffic Control Plan shall-conform to the 2006 California Manual on Uhiform Traffic Control Devices(MUTCb). ' 10. Replace,as directed by the City Engineer,any damaged or removed improvements in accordance with City Standards and Specifications at the sole.expense of the Permittee as expeditiously as possible. 11. Sawcutfor all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements. 12. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 13, Work on artehais and ccliectofs nnay require the use of changeable message boards.Adequate signing and barricading is required on the job site.Failure to provide such signingand barricading may result in the City's providing signing and barricades and charging the cost(including all labor and materials)against the construction cash deposit. 14. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required'unless othervAse stated by the City Engineer. 1E. The Contractor or Permittee will have-a supervisory representative available for contact on the project at all limes during construction.Contractor or Permittee shall provide a phone'numbe.rat which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m.and on weekends. 16. No storage of materials or equipment will be allowed near the edge of the pavement.the traveled way,or within the shoulderline which would create a hazardous condition to the public. 17. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the Work or any other work for which a separate permit may be required,nor does it relieve the Permittee of any obligation to obtain any other permit required by faw. 18. This permit does not release the Permittee from any liabilities contained in other agreements or confratts with the City and any other public agency. 19. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 20. Call back(tall out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 21. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material Into the municipal storm drain system other than .storm water.Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban,Runoff Pollution Prevention Program. 22. If the public interest requires a modification of,.or a departure from the permit,plans,special provisions and/or specifications,the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made. 23. Permittee must provide advance notification to all parties that may be affected by the permit activities,Notification shall be reviewed by the City prior to distribution and Include dates of work and a contact name and a phone number. 24. Appli6rlt shall remove water frorn utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ 2014-01'14- DWQ, Said vault watershall not be discharged into the City of Campbell's storm drain system. See r�ttpf/vw✓w.waterboard<_.ca.gov/water.issueslproRrams!nodes/utiiitwaultssi,tmt for more information: Applicant is h responsible fo ens ing that all those providing serv�ceess under the applicant are aware of and abide by all of the above conditions. fit T �V( $ pP Date: Contractor (Print Name) Date; i:\FORMS\Tempiates\Encroachmeht Permits\Encroachment Permit STATIC form2.pdf Rev.02/18 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2018-00 94 i Name: Jim Free, Campbell Memorial @ City Hall Property Address: 70 N. First St. Date of Final Inspection: On File: Bonds CD Cash Faithful Performance: $ Labor and Material: $ Construction Cash Deposit to be released: $ Other overdue deposits to be released (Description): Processed by: 31ci I I I 'Idministrator Reviewed by: 4 ! I Inspector Reviewed by: C_ + l Land Development Engin er I i JAJoAnnaT\Deposit refunds\CHECKLISTS\1 Checklist-Final Acceptance.doc(Rev. 10/11) STROU-1 OP ID: MM CERTIFICATE OF LIABILITY INSURANCE DATE 03/23/2018DD/Y Y) V 018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement.on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 916-676-0844 CONTACT Eddie Berg PRODUCER NAME: Beach&O'Neill Insurance PHONE 916-676-0844 FAX 916-676-0860 License#OE22542 (AIC,No,Ext): (A/C,No): 7520 Greenback Ln E-MAIL Citrus Heights,CA 95610 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Tokio Marine Specialty Ins 23850 INSURED Strouss Bros.Construction Inc INSURER B:American Fire and Casualty Co 24066 Dba: Metro Concrete, Inc. 700 Comstock St. INSURER C: Santa Clara,CA 95054 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L IN D WVD M DD/YYYY MM/DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR X PPK1757255 01/01/2018 01/01/2019 " PREMISES Ea occurrence) $ 100'000 MED EXP(Any oneperson) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X. ANY AUTO BAA67617610 01/01/2018 01/01/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAR I CLAIMS-MADE PUB612842 01/01/2018 01/01/2019 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:City Hall Memorial Site I City Of Campbell,its officers,employees and volunteers are named as Additional Insured per endorsement CG2010 0413. 'Primary Wording applies per attached endorsement. 'This certificate revises old ceritifcate dated 12/28/17- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Campbell ACCORDANCE WITH THE POLICY PROVISIONS. 701 N. First St. Campbell, CA 95008 AUTHORIZED REPRESENTATIVE UJIM ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PPK1757255 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additionall Insured Person(s) Or Organization(s)_ Location(*_Of Covered_O L)erations ,M- TwjHE RE RFQURED By WRIT ' A T,17 'C'V'Z—7RED I C J,+s 10 LOS S' Information required to comelete this Schedule, if not shown above,will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to E. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to .'bodily injury"or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, part,,-, or 1. Your acts or omissions',or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project, (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of 'your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the,same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to insurance shown in the Declarations; Section Ili—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 04 13 Policy Number: PPK1757255 PIC-GLN-020 (10/13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY ARID NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following_ COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,4.Other Insurance, and all subparts thereof, as contained in the policy is deleted in its entirely and replaced with the following condition: 4. Other Insurance If all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties, to provide insurance that is primary and noncontributory, and the"insured contract" is executed prior to any loss. Where required by a written contract signed by both parties, this insurance will be primary and non-contributing only when and to the extent as required by that contract. However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contributory by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit if insurance to the total applicable limits of insurance of all insurers. All other terms, conditions and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 (MM/DD/YYYY) �►�� ,� CERTIFICATE OF LIABILITY INSURANCE 03/23/2018 THIS ERT`T'CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS " CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE. COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE -OR PRODUCER,.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).. PRODUCER CONTACT NAME: NE Self Insured Solutions (A/C,No, Eit): (800)592-0047 WC,No,Ext): (800)592-2541 Administrator,California Contractors Network,Inc. E-MAIL . �C�/I/LC ADDRESS: siscerts@selfinsuredsolutions.com 430 N Vineyard Ave:.#T02 ArR INSURER(S)AFFORDINGCOVERAGE . NAICfi Ontario,CA 91764 !6 ®� ��' INSURER A; California Contractors,Network,-Inc;* INSURED pDlic INSURER Bi New York Marine and General Insurance Company. 16608 Strouss Bros.Construction,Inc. work'Admlgjstr INSURERC: Affiliate of California Contractors Network,Inc. 8 Oy RERD: 700 Comstock St. INSURER E' Santa Clara,CA 95054 INSURER F: COVERAGES' CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY EQUIREMENT,TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP.ECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER - - - POLICY EFF POLICY EXP. - - - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM DD Yyyx) (MM/6D/YYYYI LIMITS. . COMMERCIAL-GENERAL LIABILITY EACH OCCURRENCE. $. CLAIMS-MADE: ❑OCCUR DAMAGE TO RENTED - $;- PREMISES(Ea occurrence) . MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APP LIES PER: GENERAL AGGREGATE $. . POLICY. �PRO1ECTaLOC - PRODUCTS-COMP/OP:AGG. s� - OTHERIs AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $.- (Ea accident)- ANY AUTO BODILY INJURY(Per person) $ ANYOWNED SCHEDULED ❑ ❑. BODILY INJURY(Per accident) $ AUTOS AUTOS _ HIRED AUTOS NON-OWNED - - - PROPERTY DAMAGE $. AUTO - - - (Per accident) .. - UMBRELLA LIP OCCUR EACH OCCURRENCE $_ EXCESS LIAB cLAIMs-MADE F7 AGGREGATE $ DED. . . RETENTION$ WORKERS COMPENSATION wcsrniu- oTH- ANDEMPLOYERS'LIABILITY Y/N .TORYLIMITS ER A ANY PROPRIETOR/PARTNER/.EXECUTIVE OFFICE/ EMBER EXCLUDED? .L N/A a INT-4503-0264 - 01/01/2018 01/01/2019 EEACH ACCIDENT $5,000,000.00 M (Mandatory in NH) - - - E.L.DISEASE-.EA EMPLOYEE' $5,000;000.00 If yes,describe under . . -. - - - -- '- - - DESCRIPTION OF OPERATIONS belbw - - E.L.DISEASE-POLICY LIMIT $S,000,000.00 B EXCESS WORKERS COMPENSATION. WC201SEPPOO181 01/01/2018 OV01/2019 - - AND EMPLOYERS.LIABILITY Applicable to WC Statutory Limits and Employers Liability Limits. - DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required). RE:70 N First Street Campbell CA 95008 Location:City Hall Memorial **Waiver of Subrogation applies-see attached** Should any of the above described policies be cancelled before the expiration date thereof,notice will{'.'be delivered in accordance with the policy provisions **See Notes** *Complies with the requirements of the Director of Industrial Relations.uncl&the provisions of Sections 3700 to 3705,16clusive,of the Labor Code of the State of California,holder of Master Certificate of Consent to Self-Insure No:4503 LA CERTIFICATE HOLDER CANCELLATION SHOULD ANY.OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Campbell THE EXPIRATION. DATE THEREOF, NOTICE WILL BE, DELIVERED ;IN City of Campbell ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 70 N.First Street, AUTHORIZED REPRESENTATIVE' A Campbell,CA 95008 A.Seegm _ ��n€� I - � p iller ,t �.. ©1988-2016 ACORD CORPORATION. All rights reserved . ACORD 25(2614/01) The ACCORD name and logo are registered marks of ACORD PAGE 2 ` NOTEPAD: INSUREDS NAME: Strouss Bros.Construction,Inc. DATE: 03/23/2018 The City,its,officers,employees and volunteers. WORKERS COMPENSATION AND EMPLOYERS LIABILITY California Contractors Network, Inc. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS We have the right to recover our payments from anyone liable for a covered injury. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies_ only to the extent_that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate,directly or indirectly to benefit anyone not named in the Schedule. Schedule Name of Person or Organization: The City of Campbell City of Campbell Public Works Department 70 N.First Street Campbell CA R5008 The City,its officers,employees and volunteers. Insured: Strouss Bros.Construction, Inc. Policy No.: INT-450370264 Metro Concrete